Wongtanasarasin Wachira, Ungrungseesopon Nat, Phinyo Phichayut
Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA.
J Clin Med. 2022 May 29;11(11):3067. doi: 10.3390/jcm11113067.
Since current cardiac arrest guidelines do not address the benefit of blood glucose measurement, the ideal ranges and target of blood glucose (BG) levels during cardiac arrest to achieve a better result are warranted. We intended to investigate the associations between intra-arrest BG levels and outcomes of cardiac arrest resuscitation at the emergency department (ED). We conducted a retrospective observational study at a single university hospital. Cardiac arrest patients at the ED between 2017 and 2020 were included. Multivariable logistic regression analysis was performed to examine the associations between intra-arrest BG levels and clinical outcomes. We categorized intra-arrest BG into five groups: <70 mg/dL, 70−99 mg/dL, 100−180 mg/dL, 181−250 mg/dL, and >250 mg/dL. Eight hundred and nineteen patients experienced ED cardiac arrest during the study period. Of all, 385 intra-arrest BG measurements were included in the data analysis. The mean age was 60.4 years. The mean intra-arrest BG level was 171.1 mg/dL, with 64 (16.6%) patients who had intra-arrest BG level below 70 mg/dL and 73 (19.0%) patients who had intra-arrest BG level more than 250 mg/dL. Markedly low (<70 mg/dL) and low (70−99 mg/dL) intra-arrest BG levels were significantly associated with a lower chance of return of spontaneous circulation (ROSC, OR 0.36, 95% CI 0.14−0.99, p = 0.05 and OR 0.33, 95% CI 0.12−0.93, p = 0.04, respectively). For patients who experienced cardiac arrest at the ED, an intra-arrest BG level of less than 100 was inversely correlated with sustained ROSC. Although we could not draw a causal relationship between variables concerning this study design, normalizing intra-arrest BG was shown to result in good clinical outcomes.
由于当前的心脏骤停指南未涉及血糖测量的益处，因此有必要明确心脏骤停期间血糖（BG）水平的理想范围和目标，以取得更好的结果。我们旨在研究心脏骤停期间的BG水平与急诊科（ED）心脏骤停复苏结局之间的关联。我们在一家大学医院进行了一项回顾性观察研究。纳入了2017年至2020年间在急诊科发生心脏骤停的患者。进行多变量逻辑回归分析以检验心脏骤停期间BG水平与临床结局之间的关联。我们将心脏骤停期间的BG分为五组：<70mg/dL、70−99mg/dL、100−180mg/dL、181−250mg/dL和>250mg/dL。在研究期间，有819名患者在急诊科发生心脏骤停。其中，385次心脏骤停期间的BG测量值纳入了数据分析。平均年龄为60.4岁。心脏骤停期间的平均BG水平为171.1mg/dL，其中64名（16.6%）患者的心脏骤停期间BG水平低于70mg/dL，73名（19.0%）患者的心脏骤停期间BG水平高于250mg/dL。明显低（<70mg/dL）和低（70−99mg/dL）的心脏骤停期间BG水平与自主循环恢复（ROSC）的可能性较低显著相关（OR分别为0.36，95%CI为0.14−0.99，p = 0.05和OR为0.33，95%CI为0.12−0.93，p = 0.04）。对于在急诊科发生心脏骤停的患者，心脏骤停期间BG水平低于100与持续ROSC呈负相关。尽管鉴于本研究设计，我们无法得出变量之间的因果关系，但心脏骤停期间BG正常化显示可带来良好的临床结局。
